Should I get tested for prostate cancer?
Prostate cancer is the most common cancer in men, with more than 50,000 men being diagnosed every year. In this article, Mr Aidan Noon, a consultant urological surgeon explains why some men consider getting “tested” and why it isn’t always as straightforward as suggested.
Many men know a friend or relative who has been diagnosed with prostate cancer. Some men or their loved ones will have read newspaper articles or seen stories in the media about celebrities who have been diagnosed with prostate cancer. This can lead to a high level of anxiety and lead some men to consider getting evaluated for prostate cancer.
It is estimated that 12 per cent of men will be diagnosed with prostate cancer in their lifetimes, and each year there are around 12,000 prostate cancer-related deaths. Although it is more commonly diagnosed in men over 65, the risk of developing significantly increases after the age of 50, and it is likely that a lack of testing and awareness may contribute to underdiagnosis, and that many men under 50 are unaware they are in the earliest stages.
Prostate cancer tends to develop very slowly and may be asymptomatic over many years. The prostate, which is a small gland in the pelvis that produces the fluid that transports sperm from the testicles (semen), can become enlarged, and eventually becomes big enough to obstruct the urinary tract, which will typically be accompanied by symptoms such as:
- Increased frequency of urination
- Difficulty starting urination
- Painful urination
- Painful ejaculation, or inability to ejaculate
- Blood in the urine (haematuria) (This should always be evaluated by a urologist)
However, it is worth remembering that prostate glands enlarge with age, and the symptoms of a non–cancerous but enlarged prostate are often indistinguishable from prostate cancer.
Who is at risk for prostate cancer?
Aside from being older than 50 years old, there are other risk factors for prostate cancer to consider. Men who are of African descent have higher incidences of prostate cancer, and those who have a family history of prostate cancer could be at more risk of developing it, especially those who have fathers or brothers with prostate cancer and maternal relatives with breast cancer. Men who fit these characteristics should consider getting tested earlier and more frequently than their peers.
How is prostate cancer diagnosed?
Often, men who begin to struggle with symptoms seek diagnosis. In such cases, a blood test is one of the preliminary tests, which will reveal elevated levels of prostate-specific antigen (PSA). However, an enlarged prostate and the accompanying symptoms are not necessarily indicative of prostate cancer – an enlarged prostate commonly occurs in ageing men due to a hormone called dihydrotestosterone which triggers growth. When the prostate enlarges or becomes inflamed, it begins to produce PSA. High levels of PSA can be due to benign prostate enlargement (BPE), prostatitis, a urinary tract infection (UTI) and ageing. To confirm the diagnosis, further tests such as digital rectal exams (DRE), MRIs, and prostate biopsies may be performed. Some men will require several tests to have prostate cancer diagnosed – it is worth remembering that not all prostate cancers are recommended to be treated.
Why is prostate cancer screening not currently widespread in the UK?
Evaluating a man who has contacted a health professional with new urinary symptoms and checking him for prostate cancer is different to testing a 'well' man for prostate cancer who wants reassurance that he doesn’t have prostate cancer. The first situation is a common pathway for UK healthcare professionals (general practitioners and urologists) and there is an established protocol, with scientific evidence supporting it. The latter situation is screening, where there is currently a shortfall in scientific evidence and still some concerns. To date we don’t have a single (or combination of) reliable test that will identify all men with prostate cancer that will benefit them should they undergo treatment. The PSA blood test is known to be unreliable in checking asymptomatic men for clinically significant (cancer that may need treating) prostate cancer.
If you have concerns regarding your prostate or want to discuss being checked for prostate cancer, you can contact Mr Noon via his Top Doctors profile.